Healthcare Provider Details
I. General information
NPI: 1366546046
Provider Name (Legal Business Name): CLINTON ALLEN MUSIL JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/12/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
109 WEST WATAUGA AVENUE
JOHNSON CITY TN
37604
US
IV. Provider business mailing address
PO BOX 9054
GRAY TN
37615-9054
US
V. Phone/Fax
- Phone: 423-232-2600
- Fax: 423-232-2646
- Phone: 423-467-3600
- Fax: 423-467-3696
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0804X |
| Taxonomy | Child & Adolescent Psychiatry Physician |
| License Number | 0101240018 |
| License Number State | VA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0804X |
| Taxonomy | Child & Adolescent Psychiatry Physician |
| License Number | 29150 |
| License Number State | TN |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 29150 |
| License Number State | TN |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 0101240018 |
| License Number State | VA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 29150 |
| License Number State | TN |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | 0101240018 |
| License Number State | VA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 043641 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | VALUE OPTIONS CBHP |
| # 2 | |
| Identifier | 334969 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | VALUE OPTIONS |
| # 3 | |
| Identifier | 620582605 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CARITEN PHP WORKCO |
| # 4 | |
| Identifier | 1517319 |
| Identifier Type | MEDICAID |
| Identifier State | TN |
| Identifier Issuer | |
| # 5 | |
| Identifier | 3085205 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MAGELLAN NAVIGATOR |
| # 6 | |
| Identifier | 49866 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UBH EMPLOYER |
| # 7 | |
| Identifier | 620582605 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CARITEN PHP POS |
| # 8 | |
| Identifier | 3085205 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MAGELLAN SUMMIT |
| # 9 | |
| Identifier | 38174601 |
| Identifier Type | MEDICAID |
| Identifier State | TN |
| Identifier Issuer | |
| # 10 | |
| Identifier | 49866 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UBH SENIOR |
| # 11 | |
| Identifier | 010264626 |
| Identifier Type | MEDICAID |
| Identifier State | VA |
| Identifier Issuer | |
| # 12 | |
| Identifier | 620582605 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CARITEN PHP PPO |
| # 13 | |
| Identifier | 620582605 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CARITEN PHP HMO |
| # 14 | |
| Identifier | 043641 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | VALUE OPTIONS MED |
| # 15 | |
| Identifier | 1050956 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA MCC |
| # 16 | |
| Identifier | 3085205 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MAGELLAN PINNACLE |
| # 17 | |
| Identifier | 043641 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | VALUE OPTIONS |
| # 18 | |
| Identifier | 1125291 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FIRST HEALTH |
| # 19 | |
| Identifier | 49866 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UBH HEALTHPLAN |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
